Description, Causes and Risk Factors: Abbreviation: PMS. Premenstrual syndrome is a group of symptoms linked to the menstrual cycle (the period in which an ovum matures, is ovulated, and enters the uterine lumen via the fallopian tubes; ovarian hormonal secretions effect endometrial changes such that, if fertilization occurs, nidation will be possible; in the absence of fertilization, ovarian secretions wane, the endometrium sloughs, and menstruation begins; this cycle lasts an average of 28 days, with day 1 of the cycle designated as that day on which menstrual flow begins). PMS symptoms occur in the week or two weeks before your period (menstruation or monthly bleeding). The symptoms usually go away after your period starts. PMS can affect menstruating women of any age. It is also different for each woman. PMS may be just a monthly bother or it may be so severe that it makes it hard to even get through the day. Monthly periods stop during menopause, bringing an end to PMS. The causes of PMS are not clear. It is linked to the changing hormones during the menstrual cycle. Fluctuating hormone levels through the menstrual cycle have an effect on the production of neurotransmitters (particularly serotonin) in the brain. Some women may be affected more than others by changing hormone levels during the menstrual cycle. Stress and emotional problems do not seem to cause PMS, but they may make it worse. In most of the women, PMS occurs:

• Between their late 20s and early 40s.
• Have at least one child.
• Have a family history of depression.
• Have a past history of postpartum depression or a mood disorder.

Estimates of the percentage of women affected by PMS vary widely. According to the ACOG (American College of Obstetricians and Gynecologists) at least 85 percent of menstruating women have at least one PMS symptom as part of their monthly cycle. Most of these women have symptoms that are fairly mild and do not need treatment. Some women (about three to eight percent of menstruating women) have a more severe form of PMS, called premenstrual dysphoric disorder. Symptoms: PMS often includes both physical and emotional symptoms. Symptoms vary from one woman to another. Common symptoms may include:

• Feeling tired.
• Having trouble sleeping.
• Disinterest in daily activities and relationships.
• Acne.
• Breast swelling and tenderness.
• Upset stomach, bloating, constipation, or diarrhea.
• Headache or backache.
• Appetite changes or food cravings.
• Joint or muscle pain.
• Trouble concentrating or remembering.
• Tension, irritability, mood swings, or crying spells.
• Anxiety or depression

Diagnosis: The diagnosis of PMS can be difficult because many medical and psychological conditions can mimic or worsen symptoms of PMS. There are no blood or laboratory tests to determine if a woman has PMS. When laboratory tests are performed, they are used to exclude other conditions that can mimic PMS. Diagnosis of PMS is usually based on your symptoms, when they occur, and how much they affect your life. The most helpful diagnostic tool is the menstrual diary, which documents physical and emotional symptoms over months. If the changes occur consistently around ovulation (midcycle, or days 7-10 into the menstrual cycle) and persist until the menstrual flow begins, then PMS is probably the accurate diagnosis. Keeping a menstrual diary not only helps the healthcare provider to make the diagnosis, but it also promotes a better understanding by the patient of her own body and moods. Once the diagnosis of PMS is made and understood, the patient can better cope with the symptoms. Treatment: If you think you have PMS, keep track of which symptoms you have and how severe they are for a few months. You can use a calendar to write down the symptoms you have each day or you can use a form to track your symptoms. Many things have been tried to ease the symptoms of PMS. No treatment works for every woman, so you may need to try different ones to see what works. If your PMS is not so bad that you need to see a doctor, some life­style changes may help you feel better. They may include:

• Regular meals and snacks containing starchy carbohydrate. Avoid leaving longer than about 3 hours without something to eat - just a piece of fruit will be sufficient between meals to top up the blood sugar slowly and prevent you from getting too hungry between meals.
• Try to reduce the quantity of high sugar, highly processed carbohydrate foods you eat eg, sweets, sweet biscuits & cakes, sugary drinks.
• Wholegrain breakfast cereals like porridge, wheatflakes, bran flakes, shredded wheat or mueslis. Wholemeal or granary bread/rolls/toast/crackers/pittas or muffins. Brown rice, Basmati rice, pasta, pasta or rice salads (low fat dressings) jacket potatoes, sweet potatoes, new potatoes. Fruit and vegetables generally, and nuts in small amounts.
• Try to reduce your salt intake (rather than your fluid intake) particularly at the pre-menstrual time. Around 75% of salt we eat is hidden in our foods, those having the highest amounts include: take-away and processed foods, tinned soups, tinned vegetables, salted meats (bacon, ham, corned beef), savoury snacks (crisps etc) and ready meals. For general health, particularly heart health, it is a good idea to reduce salt in the diet generally.
• Some studies have suggested that consumption of caffeine is strongly related to PMS symptoms whereas others suggest less of a relationship. It might be worth trying to reduce caffeine over a 3-4 month period and see if this does improve symptoms; try decaffeinated drinks, herbal drinks, more water and less cola and chocolate.
• Exercise regularly.
• Get enough sleep. Try to get 8 hours of sleep each night.
• Take a multivitamin every day that includes folic acid. A calcium supplement with vitamin D can help keep bones strong and may help ease some PMS symptoms.
• Other supplements may include: Magnesium, vitamin B6, vitamin E, isoflavones, and evening primrose oil. Side effects positive.

In more severe cases of PMS, prescription medicines may be used to ease symptoms. One approach has been to use drugs such as birth control pills to stop ovulation from occurring. Women on the pill report fewer PMS symptoms, such as cramps and headaches, as well as lighter periods. NOTE: The above information is educational purpose. The information provided herein should not be used during any medical emergency or for the diagnosis or treatment of any medical condition. DISCLAIMER: This information should not substitute for seeking responsible, professional medical care.